title: The CLOSER (CLarifying Vaginal Atrophy's Impact On SEx and Relationships) survey: implications of vaginal discomfort in postmenopausal women and in male partners.
abstract: BACKGROUND
  Postmenopausal vaginal atrophy (VA) is a chronic condition with symptoms that include vaginal dryness, soreness, itching, burning, and dyspareunia.
  
  
  OBJECTIVE
  The CLarifying Vaginal Atrophy's Impact On SEx and Relationships survey evaluated the impact of VA on the physical and emotional aspects of sexual relationships between postmenopausal women and their male partners.
  
  
  METHODS
  Four thousand one hundred females and 4,100 males representing the United Kingdom, Finland, Norway, Sweden, Denmark, Italy, France, Canada, and the United States were surveyed. Assessments included: (i) talking about VA and its symptoms; (ii) the impact of VA on intimacy, relationships, and women's self-esteem; (iii) talking about VA and erectile dysfunction (ED); and (iv) the impact of local estrogen therapy (LET) on intimacy and relationships.
  
  
  METHODS
  Descriptive data on the impact of VA.
  
  
  RESULTS
  Twenty-eight percent of women did not tell their partners when they first encountered vaginal discomfort, mainly because they felt "it was just a natural part of growing older" (52%) or because of "embarrassment" (21%). Eighty-two percent of males wanted their partner to share their experiences with VA; males were also more comfortable discussing VA than females (68% vs. 58%, respectively). Having sex less often (women: 58%, men: 61%), less satisfying sex (women: 49%, men: 28%), and putting off having sex (women: 35%, men: 14%) were the main effects of VA. Intimacy avoidance was attributed to painful sex (women: 55%, men: 61%) and women's reduced sexual desire (women: 46%, men: 43%). Discussions about vaginal discomfort and ED were generally limited to partners and healthcare providers (HCPs). LET use resulted in less painful sex (women: 62%, men: 59%) and more satisfying sex (women: 47%, men: 49%).
  
  
  CONCLUSIONS
  VA has an adverse emotional and physical impact on postmenopausal women and their partners. These findings may encourage more open communication about VA between couples and their HCPs.
authors.affiliation: Research Center for Reproductive , Medicine, Gynecological Endocrinology and Menopause Unit, Department of Obstetrics and Gynecology, IRCCS "S. Matteo Foundation", University of Pavia, Pavia, Italy.
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
authors.forename: Sheryl
authors.initials: S
authors.lastname: Kingsberg
authors.forename: Ricardo
authors.initials: R
authors.lastname: Maamari
authors.forename: James
authors.initials: J
authors.lastname: Simon
mesh_terms: D000368:Aged; D001284:Atrophy; D002170:Canada / Q000453:epidemiology; D003142:Communication; D004414:Dyspareunia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D004644:Emotions; D007172:Erectile Dysfunction / Q000523:psychology; D015914:Estrogen Replacement Therapy; D005060:Europe / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D017698:Postmenopause; D012649:Self Concept; D012725:Sexual Behavior / Q000523:psychology; D012747:Sexual Partners / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D014623:Vaginal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy
keywords: Atrophy; Discomfort; Local Estrogen Therapy; Male Partner; Postmenopausal; Vaginal Dryness